Difficult airway management in a patient with bilateral bonytemporo-mandibular joint ankylosis by awake fiberopticbronchoscopy

Here, we present a case of difficult airway after patient consent. A young male patient presentedwith painless difficult mouth opening of 0.5 cm for 2 years, restricting him to only liquid diet. He was diagnosed as having bilateral temporomandibular joint ankylosis and was posted for release. The patient was classified as difficult for intubation with Mallampathi IV grade; systemic examination was within normal limits. Computed tomography (CT) of the temporomandibular joint showed gross bilateral osteoarthritic changes. He was planned for awake fiberoptic nasal intubation. The patient was given a detailed explanation about the procedure. The airway was prepared with topical and nebulized lignocaine. The fiberoptic bronchoscope was mounted with a 7.0 mm cuffed armored tube and inserted through the nostrils, proceeding until the vocal cords were visualized. After confirming with auscultation and by Capnography, patient was paralysed. Surgery was performed and the patient was extubated awake. Mouth opening improved to 2 cm. The use of the fiberoptic intubating bronchoscope in case of bilateral temporomandibular joint ankylosis with a high risk of airway control due to restricted mouth opening, a gift of modern technology, circumvents this difficulty without compromising on patient safety, with the patient being awake too, and should be considered a safe procedure.